Prostaglandins in severe congestive heart failure. Relation to activation of the renin-angiotensin system and hyponatremia

V. J. Dzau, M. Packer, L. S. Lilly, S. L. Swartz, N. K. Hollenberg, G. H. Williams

Research output: Contribution to journalArticle

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Abstract

To determine whether prostaglandins are involved in circulatory homeostasis in congestive heart failure, we measured plasma levels of the metabolites of vasodilator prostaglandins I2 and E2 in 15 patients with severe chronic heart failure. Mean circulating levels of both metabolites were 3 to 10 times higher than those in normal subjects. Plasma levels of both metabolites correlated directly with plasma renin activity and plasma angiotensin II concentrations (r = 0.64 and 0.84, respectively). Individual serum sodium concentrations were inversely correlated with the levels of prostaglandin E2 metabolites (r = -0.92, P<0.001) and plasma renin activity (r = -0.69, P<0.02). Of 23 patients with severe heart failure challenged with indomethacin (an inhibitor of prostaglandin synthesis), the 9 with hyponatremia had significant decreases in the cardiac index (1.99 ± 0.12 to 1.72 ± 0.13 liters per minute per square meter of body-surface area, P<0.001) and significant increases in the pulmonary capillary wedge pressure (17.4 ± 2.0 to 24.0 ± 1.9 mm Hg, P<0.001) and systemic vascular resistance (1882 ± 239 to 2488 ± 315 dyn · sec · cm-5, P<0.001), whereas the 14 patients with a normal serum sodium concentration had no significant hemodynamic changes. We conclude that both vasoconstrictor (renin-angiotensin) and vasodilator (prostaglandin) mechanisms are operative in patients with heart failure complicated by hyponatremia and that these mechanisms interact to modulate circulatory homeostasis.

Original languageEnglish (US)
Pages (from-to)347-352
Number of pages6
JournalNew England Journal of Medicine
Volume310
Issue number6
StatePublished - 1984

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Hyponatremia
Renin-Angiotensin System
Prostaglandins
Heart Failure
Renin
Vasodilator Agents
Dinoprostone
Homeostasis
Sodium
Prostaglandin Antagonists
Pulmonary Wedge Pressure
Body Surface Area
Angiotensins
Vasoconstrictor Agents
Epoprostenol
Serum
Indomethacin
Angiotensin II
Vascular Resistance
Hemodynamics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Dzau, V. J., Packer, M., Lilly, L. S., Swartz, S. L., Hollenberg, N. K., & Williams, G. H. (1984). Prostaglandins in severe congestive heart failure. Relation to activation of the renin-angiotensin system and hyponatremia. New England Journal of Medicine, 310(6), 347-352.

Prostaglandins in severe congestive heart failure. Relation to activation of the renin-angiotensin system and hyponatremia. / Dzau, V. J.; Packer, M.; Lilly, L. S.; Swartz, S. L.; Hollenberg, N. K.; Williams, G. H.

In: New England Journal of Medicine, Vol. 310, No. 6, 1984, p. 347-352.

Research output: Contribution to journalArticle

Dzau, VJ, Packer, M, Lilly, LS, Swartz, SL, Hollenberg, NK & Williams, GH 1984, 'Prostaglandins in severe congestive heart failure. Relation to activation of the renin-angiotensin system and hyponatremia', New England Journal of Medicine, vol. 310, no. 6, pp. 347-352.
Dzau, V. J. ; Packer, M. ; Lilly, L. S. ; Swartz, S. L. ; Hollenberg, N. K. ; Williams, G. H. / Prostaglandins in severe congestive heart failure. Relation to activation of the renin-angiotensin system and hyponatremia. In: New England Journal of Medicine. 1984 ; Vol. 310, No. 6. pp. 347-352.
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